COVID-19 impact on the renal system: Pathophysiology and clinical outcomes

Alan D. Kaye, Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA. Electronic address: akaye@lsuhsc.edu.
Chikezie N. Okeagu, Department of Anesthesiology, LSU Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA, 70112, USA. Electronic address: cokeag@lsuhsc.edu.
Gregory Tortorich, LSUHSC New Orleans, New Orleans, LA, USA. Electronic address: gtort1@lsuhsc.edu.
Alex D. Pham, Department of Anesthesiology, LSU Health New Orleans, 1542 Tulane Ave, Room 659, New Orleans, LA, 70112, USA. Electronic address: apham5@lsuhsc.edu.
Eric I. Ly, University of Tennessee Health Science Center College of Medicine, 910 Madison Avenue, Memphis, TN, 38103, USA. Electronic address: ely@uthsc.edu.
Kimberley C. Brondeel, School of Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA. Electronic address: kcbronde@utmb.edu.
Matthew R. Eng, Department of Anesthesiology, LSU Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA, 70112, USA. Electronic address: meng@lsuhsc.edu.
Markus M. Luedi, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland. Electronic address: markus.luedi2@insel.ch.
Richard D. Urman, Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. Electronic address: rurman@bwh.harvard.edu.
Elyse M. Cornett, Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA. Electronic address: ecorne@lsuhsc.edu.

Abstract

Coronavirus disease (COVID-19) causes many deleterious effects throughout the body. Prior studies show that the incidence of acute kidney injury in COVID-19 patients could be as high as 25%. There are also autopsy reports showing evidence of viral tropism to the renal system. In this regard, COVID-19 can damage the kidneys and increase a patient's risk of requiring dialysis. Available evidence suggests that renal involvement in COVID-19 infection is not uncommon, and there has been an increased incidence of chronic kidney disease related to the pandemic. In this literature analysis, we address COVID-19 and its effects on the renal system, including the pathophysiologic mechanisms. We also address current studies on the causes of injury to the renal system, the cause of kidney failure, its effect on mortality, the impact on dialysis patients, and the impact on renal transplant patients. COVID-19 disease may have unique features in individuals on chronic dialysis and kidney transplant recipients, requiring increased vigilance in limiting viral transmission in perioperative, in-patient, and dialysis center settings.

Publication Title

Best practice & research. Clinical anaesthesiology

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